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Hiyare-Hewage A, Sinka V, Grande ED, Kerr M, Kim S, Mallitt KA, Dickson M, Jaure A, Wilson R, Craig JC, Stephens JH. The cultural safety of research reports on primary healthcare use by Indigenous Peoples: a systematic review. BMC Health Serv Res 2024; 24:873. [PMID: 39085815 PMCID: PMC11293170 DOI: 10.1186/s12913-024-11314-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION Community-driven research in primary healthcare (PHC) may reduce the chronic disease burden in Indigenous peoples. This systematic review assessed the cultural safety of reports of research on PHC use by Indigenous peoples from four countries with similar colonial histories. METHODS Medline, CINAHL and Embase were all systematically searched from 1st January 2002 to 4th April 2023. Papers were included if they were original studies, published in English and included data (quantitative, qualitative and/or mixed methods) on primary healthcare use for chronic disease (chronic kidney disease, cardiovascular disease and/or diabetes mellitus) by Indigenous Peoples from Western colonial countries. Study screening and data extraction were undertaken independently by two authors, at least one of whom was Indigenous. The baseline characteristics of the papers were analyzed using descriptive statistics. Aspects of cultural safety of the research papers were assessed using two quality appraisal tools: the CONSIDER tool and the CREATE tool (subset analysis). This systematic review was conducted in accordance with the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool. RESULTS We identified 35 papers from Australia, New Zealand, Canada, and the United States. Most papers were quantitative (n = 21) and included data on 42,438 people. Cultural safety across the included papers varied significantly with gaps in adequate reporting of research partnerships, provision of clear collective consent from participants and Indigenous research governance throughout the research process, particularly in dissemination. The majority of the papers (94%, 33/35) stated that research aims emerged from communities or empirical evidence. We also found that 71.4% (25/35) of papers reported of using strengths-based approaches by considering the impacts of colonization on reduced primary healthcare access. CONCLUSION Research on Indigenous PHC use should adopt more culturally safe ways of providing care and producing research outputs which are relevant to community needs by privileging Indigenous voices throughout the research process including dissemination. Indigenous stakeholders should participate more formally and explicitly throughout the process to guide research practices, inclusive of Indigenous values and community needs.
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Affiliation(s)
- Amandi Hiyare-Hewage
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Victoria Sinka
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Eleonora Dal Grande
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Marianne Kerr
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Siah Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Kylie-Ann Mallitt
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Michelle Dickson
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Allison Jaure
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Rhonda Wilson
- Department of Nursing, RMIT University, Melbourne, Australia
| | - Jonathan C Craig
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jacqueline H Stephens
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Martin S, Dill J, Demeritte D, Geressu H, Dahal R, Kirkland C, Hunt S, Parikh R. A Scoping Review of Health Equity Interventions in Governmental Public Health. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:479-489. [PMID: 38830006 DOI: 10.1097/phh.0000000000001947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
CONTEXT Despite major efforts in research, practice, and policy, racial and ethnic disparities in health and health care persist in the United States. Interventions in collaboration with governmental public health may provide ways to address these persistent racial and ethnic health and health care disparities and improve health outcomes. OBJECTIVE To conduct a comprehensive review of health equity interventions performed in collaboration with public health agencies. DESIGN This scoping review includes intervention studies from Ovid MEDLINE, PsycINFO, and Academic Search Premier, published between 2017 and 2023. The search strategy used terminology focused on 4 concepts: race/ethnicity, equity, health departments, and epidemiologic studies. ELIGIBILITY CRITERIA The following inclusion criteria were determined a priori: (1) intervention tailored to reduce racial/ethnic health disparities, (2) public health department involvement, (3) health outcome measures, (4) use of epidemiologic study methods, (5) written in English, (6) implemented in the United States, (7) original data (not a commentary), and (8) published between January 2017 and January 2023. MAIN OUTCOME MEASURES This review focused primarily on 4 dimensions of racial health equity interventions including intervention components, intervention settings, intervention delivery agents, and intervention outcomes. RESULTS This review indicated that health equity interventions involving public health agencies focused on the following categories: (1) access to care, (2) health behavior, (3) infectious disease testing, (4) preventing transmission, and (5) cancer screening. Critical strategies included in interventions for reaching racial/ethnic minoritized people included using community settings, mobile clinics, social media/social networks, phone-based interventions, community-based workers, health education, active public health department involvement, and structural/policy change. CONCLUSIONS This scoping review aims to provide an evidence map to inform public health agencies, researchers, and funding agencies on gaps in knowledge and priority areas for future research and to identify existing health equity interventions that could be considered for implementation by public health leaders.
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Affiliation(s)
- Skky Martin
- Author Affiliations: Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota
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Engstrom T, Lobo EH, Watego K, Nelson C, Wang J, Wong H, Kim SL, Oh SI, Lawley M, Gorse AD, Ward J, Sullivan C. Indigenous data governance approaches applied in research using routinely collected health data: a scoping review. NPJ Digit Med 2024; 7:68. [PMID: 38491156 PMCID: PMC10943072 DOI: 10.1038/s41746-024-01070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/29/2024] [Indexed: 03/18/2024] Open
Abstract
Globally, there is a growing acknowledgment of Indigenous Peoples' rights to control data related to their communities. This is seen in the development of Indigenous Data Governance standards. As health data collection increases, it's crucial to apply these standards in research involving Indigenous communities. Our study, therefore, aims to systematically review research using routinely collected health data of Indigenous Peoples, understanding the Indigenous Data Governance approaches and the associated advantages and challenges. We searched electronic databases for studies from 2013 to 2022, resulting in 85 selected articles. Of these, 65 (77%) involved Indigenous Peoples in the research, and 60 (71%) were authored by Indigenous individuals or organisations. While most studies (93%) provided ethical approval details, only 18 (21%) described Indigenous guiding principles, 35 (41%) reported on data sovereignty, and 28 (33%) addressed consent. This highlights the increasing focus on Indigenous Data Governance in utilising health data. Leveraging existing data sources in line with Indigenous data governance principles is vital for better understanding Indigenous health outcomes.
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Affiliation(s)
- Teyl Engstrom
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia.
| | - Elton H Lobo
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia.
| | - Kristie Watego
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Carmel Nelson
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Jinxiang Wang
- Poche Centre for Indigenous Health, The University of Queensland, Herston, QLD, Australia
| | - Howard Wong
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Sungkyung Linda Kim
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Soo In Oh
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | | | | | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland, Herston, QLD, Australia
| | - Clair Sullivan
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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Reece S, McElfish PA, Andersen JA, Ayers BL, Tiwari T, Willis DE, Rowland B, Norris JD, Beasley K, Mendoza Kabua P, Brown CC. Application Status Among Women Enrolled in a Healthy Start Program in Arkansas for the Special Nutrition Program for Women and Children. J Community Health 2023; 48:724-730. [PMID: 37000375 PMCID: PMC10063932 DOI: 10.1007/s10900-023-01215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/01/2023]
Abstract
This study aimed to examine the demographic characteristics of pregnant women in a Healthy Start program who are presumed eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), but who have not yet applied for WIC benefits. We used a cross sectional evaluation of data collected from pregnant women (n=203) participating in a Healthy Start program. Data came from surveys administered at enrollment in the Healthy Start program from July 15th, 2019 until January 14th, 2022. The primary outcome was WIC application status, which was determined by whether the woman had applied or was receiving benefits at the time of enrollment. Covariates included race/ethnicity, marital status, insurance, education, income, age, employment, and having previous children/pregnancies. Fisher exact tests and logistic regression were used to examine associations. Approximately 65% of women had not yet applied for WIC benefits. Marshallese women (80.9%) and other NHPI women (80.0%) had the highest need for assistance. In adjusted analyses, White women (p = 0.040) and Hispanic women (p = 0.005) had lower rates of needing assistance applying for WIC than Marshallese women. There were higher rates of needing assistance in applying for women with private insurance or with no insurance and for those with higher incomes. Nearly two out of every three pregnant women who were eligible for WIC had not yet applied for benefits. The findings highlight the need for outreach for all populations that may be eligible, particularly among racial/ethnic minorities and those with higher incomes.
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Affiliation(s)
- Sharon Reece
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703 USA
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703 USA
| | - Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Jennifer A. Andersen
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Britni L. Ayers
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Tanvangi Tiwari
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Don E. Willis
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th Street, Springdale, AR 72762 USA
| | - Jacqueline D. Norris
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703 USA
| | - Kristen Beasley
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703 USA
| | - Philmar Mendoza Kabua
- College of Nursing, University of Arkasnas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703 USA
| | - Clare C. Brown
- University of Arkansas for Medical Sciences Fay W Boozman College of Public Health, 4301 W. Markham St, Little Rock, AR 72205 USA
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D’Apice C, Ghirotto L, Bassi MC, Artioli G, Sarli L. A realist synthesis of staff-based primary health care interventions addressing universal health coverage. J Glob Health 2022; 12:04035. [PMID: 35569053 PMCID: PMC9107778 DOI: 10.7189/jogh.12.04035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Clelia D’Apice
- University of Parma, Department of Medicine and Surgery, Parma, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL – IRCCS, Reggio Emilia, Italy
| | - Maria C Bassi
- Medical Library, Azienda USL – IRCCS, Reggio Emilia, Italy
| | - Giovanna Artioli
- University of Parma, Department of Medicine and Surgery, Parma, Italy
| | - Leopoldo Sarli
- University of Parma, Department of Medicine and Surgery, Parma, Italy
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Kruse G, Lopez-Carmen VA, Jensen A, Hardie L, Sequist TD. The Indian Health Service and American Indian/Alaska Native Health Outcomes. Annu Rev Public Health 2022; 43:559-576. [PMID: 35081315 DOI: 10.1146/annurev-publhealth-052620-103633] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Indian Health Service (IHS) has made huge strides in narrowing health disparities between American Indian and Alaska Native (AI/AN) populations and other racial and ethnic groups. Yet, health disparities experienced by AI/AN people persist, with deep historical roots combined with present-day challenges. Here we review the history of the IHS from colonization to the present-day system, highlight persistent disparities in AI/AN health and health care, and discuss six key present-day challenges: inadequate funding, limited human resources, challenges associated with transitioning services from federal to Tribal control through contracting and compacting, evolving federal and state programs, the need for culturally sensitive services, and the promise and challenges of health technology.
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Affiliation(s)
- Gina Kruse
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Anpotowin Jensen
- School of Engineering, Stanford University, Stanford, California, USA
| | - Lakotah Hardie
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;
| | - Thomas D Sequist
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Quality and Patient Experience, Massachusetts General Brigham, Somerville, Massachusetts, USA
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Ridberg RA, Yaroch AL, Nugent NB, Byker Shanks C, Seligman H. A Case for Using Electronic Health Record Data in the Evaluation of Produce Prescription Programs. J Prim Care Community Health 2022; 13:21501319221101849. [PMID: 35603984 PMCID: PMC9134408 DOI: 10.1177/21501319221101849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Produce prescription programs within clinical care settings can address food insecurity
by offering financial incentives through “prescriptions” for fruits and vegetables to
eligible patients. The electronic health record (EHR) holds potential as a strategy to
examine the relationship between these projects and participant outcomes, but no studies
address EHR extraction for programmatic evaluations. We interviewed representatives of 9
grantees of the U.S. Department of Agriculture’s Gus Schumacher Nutrition Incentive Grant
Program’s Produce Prescription Projects (GusNIP PPR) to understand their experiences with
and capacity for utilizing EHR for evaluation. Five grantees planned to use EHR data, with
3 main strategies: reporting aggregate data from health clinics, contracting with
external/third party evaluators, and accessing individual-level data. However, utilizing
EHRs was prohibitive for others due to insufficient knowledge, training and/or staff
capacity; lack of familiarity with the Institutional Review Board process; or was
inappropriate for select target populations. Policy support for produce prescription
programs requires a robust evidence base, deep knowledge of best practices, and an
understanding of expected health outcomes. These insights can be most efficiently and
meaningfully achieved with EHR data, which will require increased financial support and
technical assistance for project operators.
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Affiliation(s)
- Ronit A Ridberg
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Amy L Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | | | | | - Hilary Seligman
- University of California San Francisco, San Francisco, CA, USA
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Osuagwu UL, Sharma S, Silva D, Saunders J, Pillay J, Piya MK, Simmons D. Assessment of diabetes knowledge, screening and uptake of community diabetes programs in a peri-urban region in Australia. Diabetes Metab Syndr 2021; 15:102257. [PMID: 34425557 DOI: 10.1016/j.dsx.2021.102257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/02/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022]
Abstract
AIMS The Wollondilly Diabetes Program (WDP) is testing ways to improve uptake of diabetes prevention services. This project evaluated the reach of WDP in diabetes promotion while assessing diabetes knowledge and risk among residents. METHODS A WDP member travelled in the DW weekly to community events including outreach programs between October 2016 and June 2019. Data from diabetes knowledge questionnaire (DKQ), the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK), HbA1c and Random Blood Glucose (RBG) measurements obtained from participants who attended community events and road shows. RESULTS Over the 32 months period, WDP attended 32 community events reaching 1415 people (∼3% of the Wollondilly adult population). DKQ was completed by 154 people (52.9% females, 78% Australian born, median age 69 years), 39% had diabetes and their mean score (25.0 ± 3.1, maximum possible score = 31) was similar to those without diabetes (24.0 ± 4.6, p = 0.093). AUSDRISK assessment was completed by 166 people with 85% at intermediate or high risk of diabetes. There were 65% results above range for RBG (≥5.5 mmol/l) and/or HbA1c (≥5.7%,39 mmol/mol). CONCLUSION A community outreach team set up in partnership with local stakeholders that offers opportunistic diabetes screening, is an effective way of engaging with the community to increase diabetes awareness and knowledge.
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Affiliation(s)
- Uchechukwu Levi Osuagwu
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia; Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560 Australia.
| | - Suryansh Sharma
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - Dilan Silva
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - James Saunders
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - Jayeshwari Pillay
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - Milan K Piya
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia; Macarthur Diabetes Endocrinology and Metabolism Service, Campbelltown Hospital, Campbelltown, NSW, 2560, Australia.
| | - David Simmons
- Diabetes, Obesity, and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia; Macarthur Diabetes Endocrinology and Metabolism Service, Campbelltown Hospital, Campbelltown, NSW, 2560, Australia.
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Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063196. [PMID: 33808769 PMCID: PMC8003472 DOI: 10.3390/ijerph18063196] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 01/02/2023]
Abstract
Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and outcomes including disabling and life-threatening complications among patients with diabetes. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordination, and psychosocial support for patients and their caregivers. The purpose of this study was to examine the association between race/ethnicity and hospital discharge to home health care and subsequent utilization of home health care among a cohort of adults (age 50 and older) who experienced a diabetes-related hospitalization. The study was limited to patients who were continuously enrolled in Medicare for at least 12 months and in the United States. The cohort (n = 786,758) was followed for 14 days after their diabetes-related index hospitalization, using linked Medicare administrative, claims, and assessment data (2014–2016). Multivariate logistic regression models included patient demographics, comorbidities, hospital length of stay, geographic region, neighborhood deprivation, and rural/urban setting. In fully adjusted models, hospital discharge to home health care was significantly less likely among Hispanic (OR 0.8, 95% CI 0.8–0.8) and American Indian (OR 0.8, CI 0.8–0.8) patients compared to White patients. Among those discharged to home health care, all non-white racial/ethnic minority patients were less likely to receive services within 14-days. Future efforts to reduce racial/ethnic disparities in post-acute care outcomes among patients with a diabetes-related hospitalization should include policies and practice guidelines that address structural racism and systemic barriers to accessing home health care services.
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